New extended reality (XR) program could enhance efficiency, improve accessibility of ECMO training
XR technology enables Michigan Medicine team to deliver high-quality, just-in-time training and skill assessment in uncommon yet complex medical procedure.
Contact:
Katelyn Murphy,
Marketing Communications Specialist, Weil Institute
mukately@med.umich.edu
ANN ARBOR, MI – To help a patient recover from a life-threatening condition of their heart or lungs, care teams may initiate an advanced form of life support called extracorporeal membrane oxygenation (ECMO). During ECMO, the patient is connected via tubes, or cannulas, to a machine that circulates and oxygenates their blood, essentially serving as a substitute heart and/or lung until the patient’s own can recover. From cannulating the patient to managing the ECMO machine and monitoring for side-effects, every step in the process requires a specially trained team of experts. This level of complexity, coupled with a recent increase in ECMO utilization due to COVID-19, has resulted in a critical need for ECMO-certified providers around the world.
To help meet this demand, a Michigan Medicine research team led by Dr. Taylor Kantor, a resident physician in the Division of Integrated Cardiothoracic Surgery, is developing a new extended reality (XR)-based program geared at enhancing the efficiency and effectiveness of ECMO cannulation competency training.
“Maintaining the proficiency of healthcare providers in the performance of rare, lifesaving procedures such as this can be challenging, and effective training is complicated by a lack of real-time objective measures of competency,” said Kantor. “Numerous studies exist validating XR as a tool that can improve comprehension, understanding, and efficiency of simulation training. Our team chose ECMO cannulation as our pilot for this project as we have previously developed and deployed XR simulations for various other types of vascular line insertions as well as for common nursing and bedside procedures.”
XR is an umbrella term for a group of technologies that combine holographic digital elements within the tangible, physical environment. These technologies include augmented reality (AR) in which a view of the real world is overlayed with digital elements. The team’s training program is being developed for AR headsets and will feature anatomic overlays, interactive 3D models, video tutorials, gesture guidance and other forms of immersive communication. Combined, these elements will provide exposure to ECMO cannulation in a safe-to-fail setting that can be repeated as often as needed and without the limitations associated with traditional simulation training.
“By developing an XR procedural training simulation and eventually making it accessible on a global platform, we believe we can enhance the training curricula for institutions across the world.”
Taylor Kantor, MD
ADT II / PGY V, Integrated Thoracic Surgery Residency, Cardiac Surgery
Michigan Medicine
“Our program will drive hands-on skill development adaptable for trainees of various levels, empower psychomotor skills, increase skill retention, and improve understanding of clinical variables through immersive exposure—all while also limiting the need for faculty involvement,” said Dr. Deborah Lee, Family and Acute Care Nurse Practitioner in the U-M School of Nursing, who also serves as the team’s AR content expert.
Currently, there does not exist a certification program for ECMO cannulation. Organizations such as ELSO (Extracorporeal Life Support Organization) have established training opportunities for ECMO cannulation in quarterly events at designated centers. Along with the potential travel costs that participants may incur, the simulations themselves are expensive for institutions to run, and training centers may differ in their use and availability of ECMO kits and in the supplies needed to conduct the simulations.
“By using XR, we can deploy just-in-time ECMO training at any institution around the world, any time” said content expert Dr. Cindy Hsu, Associate Professor of Emergency Medicine and Surgery, Division Chief of Critical Care, and Weil Institute member. “Our proof-of-concept veno-venous ECMO cannulation XR simulation is designed for patients who require lung support. This technology will be translatable to train clinicians for veno-arterial ECMO and extracorporeal cardiopulmonary resuscitation to provide cardiac support for patients in cardiogenic shock or cardiac arrest. Data can also be collected within the simulation to assess procedural workflow, measure trainees’ timing and understanding of the procedure, and gauge how participants respond to and manage complications that may arise.”
Earlier this summer, the team presented the training program at the Frankel Cardiovascular Center’s Innovation Challenge, where they were awarded a grand prize $100,000 grant to support prototyping and custom XR development to share and validate the XR simulation. Once the prototype is complete, the team plans to validate it using the wealth of ECMO training resources available at Michigan Medicine. They will engage resident trainees, graduate level nurses, medical students, and the University’s own expert ECMO training personnel throughout this process. Eventually, the team would like to make the program available globally.
“By developing an XR procedural training simulation and eventually making it accessible on a global platform, we believe we can enhance the training curricula for institutions across the world,” said Dr. Kantor.
“ECMO itself was invented by U-M’s own Dr. Robert Bartlett,” said Dr. Hsu. “U-M is also one of the largest ECMO training centers in the United States. There’s no better place for new research and advancements in this field to happen.”
Project Team
Taylor Kantor, M.D. (Resident, Integrated Cardiothoracic Surgery); Rishindra Reddy, M.D. (Professor, Thoracic Surgery); William Lynch, M.D. (Clinical Associate Professor, Thoracic Surgery); Ashraf Abou El Ela, M.D. (Clinical Assistant Professor, Cardiac Surgery); Cindy Hsu, M.D., Ph.D. (Assistant Professor, Emergency Medicine and Acute Care Surgery; Weil Institute Member); Deborah Lee, Ph.D., FNP, ACNP-BC (Family Nurse Practitioner, Acute Care Nurse Practitioner, School of Nursing); Vicky Huang (Graduate student)
About the Weil Institute, formerly MCIRCC
The team at the Max Harry Weil Institute for Critical Care Research and Innovation (formerly the Michigan Center for Integrative Research in Critical Care) is dedicated to pushing the leading edge of research to develop new technologies and novel therapies for the most critically ill and injured patients. Through a unique formula of innovation, integration and entrepreneurship that was first imagined by Weil, their multi-disciplinary teams of health providers, basic scientists, engineers, data scientists, commercialization coaches, donors and industry partners are taking a boundless approach to re-imagining every aspect of critical care medicine. For more information, visit weilinstitute.med.umich.edu.